Provider Demographics
NPI:1083232052
Name:BOURCIER, ASHLEY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BOURCIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2061 ENGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-1749
Mailing Address - Country:US
Mailing Address - Phone:941-681-2042
Mailing Address - Fax:
Practice Address - Street 1:900 PINE ST STE 111A
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-4457
Practice Address - Country:US
Practice Address - Phone:941-681-2042
Practice Address - Fax:941-208-5982
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11007468363LW0102X
FLAPRN11007468363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF3N5OtherBCBS